Graduation Year


Document Type




Degree Name

Doctor of Public Health (Dr.PH.)

Degree Granting Department

Public Health

Major Professor

Karen Liller, Ph.D.

Co-Major Professor

Martha Coulter, M.S.W, Dr.P.H.

Committee Member

Carla VandeWeerd, Ph.D.

Committee Member

Henian Chen, Ph.D.

Committee Member

Abraham Salinas-Miranda, Ph.D.


adult attachment, childhood exposure to intimate partner violence, insecure attachment, secure attachment


Background: Trauma in childhood including exposure to intimate partner violence is associated with a myriad of negative outcomes in physical health, mental health, academic performance, and relationship domains. Adult attachment in intimate relationships is a key factor that determines several health outcomes as well as healthy relationships. This study explored: 1) the perceptions of childhood exposures to intimate partner violence and how these exposures could have impacted adult attachment; 2) the perceptions of relationship factors that play a role in the development of adult attachment in intimate relationships; and 3) the behavioral and socioenvironmental influences that frame perceptions of adult attachment in intimate relationships.

Methods: This was a convergent mixed-methods study with self-disclosed women survivors of domestic violence (N=22). Quantitative and qualitative data were collected concurrently. The quantitative strand consisted of an online survey (n=22) about attachment styles, adverse childhood experiences, and demographics. The qualitative strand consisted of in-depth interviews (three interviews per participant, for a total of 66 interviews) with open-ended questions about how intimate partner violence exposures in childhood influenced their adult attachment, as well as the role of relationship factors, behaviors, and environmental influences. Survey data were analyzed descriptively to generate frequencies, relative frequencies, and measures of centrality and dispersion. Thematic analysis was performed for qualitative data. Mixed methods data analyses included comparative interpretation of findings, triangulation matrix, and diagrammatic representation based on study objectives.

Results: Participants were between 26 and 38 years old with childhood exposure to intimate partner violence scores ranging from 18 to 40. Most participants (n=19; 86.4%) had at least four adverse childhood experiences and the majority endorsed insecure attachment styles (n=14; 63%). Based on the interviews, participants’ perceptions of childhood exposure to intimate partner violence included negative feelings about themselves and their situations in childhood but better understanding of parental circumstances in adulthood. They perceived that their childhood exposures had affected their adult attachment in intimate relationships by leading to avoidance, anxiety, a desire not to repeat parental dynamics, yet they demonstrated repeated cycles and patterns in intimate relationships. Childhood exposure to intimate partner violence also interfered with their ability to trust or be intimate with past and/or current partners. Women perceived several behaviors, their social environment, and environmental stressors (including the social environment) to have influenced their adult attachment. Self-regulation was a behavior that could lead to secure attachment. The impact of environmental stressors on adult attachment in relationships was dependent on how the couple responded to these stressors. Furthermore, the behaviors of a partner including how supportive he or she is as well as his or her own attachment behaviors, seemed to influence adult attachment for study participants.

Conclusion: Understanding the factors that can influence individuals’ attachment styles can help inform clinical practice, therapy, and other interventions towards developing healthier relationships among women with childhood exposure to intimate partner violence.

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